title: Sequence of novel agents in multiple myeloma: an instrumental variable analysis.
abstract: Lenalidomide and bortezomib have not been compared prospectively and are currently used in sequence for patients with multiple myeloma; however, it is unknown whether a sequence of administration could result in improved outcomes. We retrospectively reviewed electronic records of patients with multiple myeloma who had used both agents in sequence at our institution: 97 patients had lenalidomide first and 111 had bortezomib first. On multivariable analysis, the sequence of therapy was not associated with outcome. These findings were confirmed with instrumental variable analyses. Finally, use of bortezomib first was associated with improved survival for patients with baseline renal insufficiency.
authors.affiliation: Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. rachid.baz@moffitt.org
authors.forename: Rachid
authors.initials: R
authors.lastname: Baz
authors.forename: Branko
authors.initials: B
authors.lastname: Miladinovic
authors.forename: Amila
authors.initials: A
authors.lastname: Patel
authors.forename: Viet Q
authors.initials: VQ
authors.lastname: Ho
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Shain
authors.forename: Melissa
authors.initials: M
authors.lastname: Alsina
authors.forename: Taiga
authors.initials: T
authors.lastname: Nishihori
authors.forename: Jose L
authors.initials: JL
authors.lastname: Ochoa-Bayona
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sullivan
authors.forename: William S
authors.initials: WS
authors.lastname: Dalton
authors.forename: Benjamin
authors.initials: B
authors.lastname: Djulbegovic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001897:Boronic Acids / Q000008:administration & dosage; D000069286:Bortezomib; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000077269:Lenalidomide; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000188:drug therapy* / Q000401:mortality; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000401:mortality; D011379:Prognosis; D011719:Pyrazines / Q000008:administration & dosage; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D013792:Thalidomide / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D001897:Boronic Acids; D011719:Pyrazines; D013792:Thalidomide; D000069286:Bortezomib; D000077269:Lenalidomide
keywords: Bortezomib; Lenalidomide; Multiple myeloma; Outcome; Survival